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The question that I am asking is "What is the Benifits of heparan when having mthfr?
The thing is that my wife was told she has mthfr and that she has 2 of the genes, on top of I have one of the genes,
The doctor only prescribed Folic acid 4milograms, b6 b12, vitamin E
And baby asperin 81milograms, now everywhere I have seen they have used Heparn, do you think that Heparan should be used and what our the side effects of Heparan?
Also right now my wife is 13 weeks pregnant, and we lost are last baby at 14 weeks, do you think it is too late to start the Heparan.
Please help me con vince my wife this is the right treatment, she will not listen to me about the Heparan, she thinks that the doctor is right and if he wants on Heparan she will be on Heparn.
Please also list the benifits of Heparan on top of the Asperin treatment.
Thankyou
Jeff Serve

This is a good question for which there is not any good evidence to support one or/over the other modalities.

First we need a bit more history:
1. Circumstances surrounding previous 13wk loss? were you quite sure about that being the actual week of pregnancy? Were there obvious problems with the baby?? (I presume this was her first loss, any previous successful pregnancies?)
2. Any personal or family history of venous thromboembolism?
3. Has she undergone (I presume yes by this point) testing for other thrombophilias & what were results?

Then we need to investigate her particular mutation. 11% of caucasians carry the AR MTHFR gene for hyperhomocyteinemia, which increases the risk of VTE 2-4x (Lockwood, 2002) How elevated are her fasting homocysteinie levels (mild/moderate/severe)? Which MTHFR mutations does she have (A/C)?

Treatment is a bit more controversial. There may or may not be a relationship between HHCemia & early pregnancy loss. I think putting her on folate, B6, & B12. (Vitamin E probably not harmful - especially if started @ <8wks but not certain of definite effect MTHFR). Heparin and low-dose Aspirin *may* improve birthweights but no conclusive evidence. Lockwood's flow charts for "lesser thrombophilias" advocate antepartum prophylactic heparin with history of adverse previous obstetrical event and postpartum if c-section or previous/family VTE.

I think you also need also consider the potential adverse effects of indiscriminate use of heparin (bleeding, thrombocytopenia, osteoporosis, 2x (or once with enoxaparin) daily injections) in situations of unproven benefit.

So to summarize, I think her physician is practicing good reasonable medicine at this point.

Best wishes!

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